Metabolic Bone Disease Wayne Cheng, Md

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METABOLIC BONE DISEASE WAYNE CHENG, MD BONES AND SPINE OSTEOPENIA • OSTEOPOROSIS • OSTEOMALACIA VITAMINE D PRODUCTION • VIT D2 • VIT D3 • 25-OH-VIT D3 • 1,25-OH VIT D3 VS. 24,25-OH VIT D3 OSTEOMALACIA- CLINICAL PRESENTATION • Diffuse pain (away from joints) • Muscle weakness (waddling gait) • Hx of prior fx (rib/spine/long bone) OSTEOMALACIA X-RAY IN ADULTS • Code fish vertebrae • Looser Zone OSTEOMALACIA- LAB. • Ca, P, Akp, PTH, 25-vit D, 1,25-Vit D OSTEOMALACIA – LAB. DISEASE CA P Akp PTH Vit.D Dep. Ricket L L H H VDRR (hypophosphotemic Nl L H N Ricket) * x link dominant Renal osteodystrophy H H H H Hypophosphatasia *AR nl nl L nl hyperparathyroid H L H H Idiopathic Juvenil osteop. nl nl nl nl OSTEOMALACIA-TREATMENT • Find the cause and treat it. OSTEOPOROSIS type I II Cause postmenopause age age 51-70 >70 F : M 6:1 2:1 Bone loss trabeculae Trabeculae+corticle Fx sites Crushed vert. Wedge vert. IT fx, wrist Femoral neck. OSTEOPOROSIS - HISTORY • Menopause • Periods of amenorrhea • Nutrition • Inacitivity • Smoking • alcohol OSTEOPOROSIS-LAB • CBC,ESR,CHEM20, SPEP,TSH,PTH OSTEOPOROSIS - IMAGING • DXA(Dual-energy x-ray absorptiometry) • Classification I to IV levels (compare to peak bone mass of young same gender) • Two fold increase of Fx. Rate with each standard deviation. OSTEOPOROSIS-TREATMENT • CALCIUM • Young adult = 1200 Mg/day • Premenopause = 1000 Mg/day • Postmenopause = 1500 Mg/day OSTEOPOROSIS-TREATMENT • VIT D • 400 IU/DAY • 800 IU/DAY MAX. OSTEOPOROSIS-TREATMENT • ESTROGEN • 0.625 MG/DAY • Contraindication: • Breast Cancer • Uterine Cancer • Thromboembolic disorders • Raloxifene(selective estrogen-receptor modulator) 60mg/day OSTEOPOROSIS - TREATMENT • Bisphosphonates • 1st generation: Etidronate • 2nd generation: Alendronate • 5mg/day prevention • 10mg/day treatment • Instruction and side effects. • 3rd generation: Risedronate OSTEOPOROSIS TREATMENT • Calcitonin • Salmon 200 IU/day • Has both analgesic and protective effects OSTEOPOROSIS TREATMENT • Flouride • Increase bone formation but impair bone mineralization. (May increase bone density but increase rate of fractures) OSTEOPOROSIS TX. PROTOCOL • Premenopause • Eumenorrheic • Ca 1000., Vit D 400, exercise • Amenorrheic • Above + estrogen or ocp OSTEOPOROSIS TX. PROTOCOL • Postmenopause • BMD <2.5 • Ca 1500, Vit D. 400, estrogen • BMD >2.5 or fracture • Above + calcitonin CONCLUSION • Best treatment of osteoporosis is prevention. • Best treatment of osteomalacia is to treat the cause..

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Osteomalacia and Osteoporosis D
Postgrad. med.J. (August 1968) 44, 621-625. Postgrad Med J: first published as 10.1136/pgmj.44.514.621 on 1 August 1968. Downloaded from Osteomalacia and osteoporosis D. B. MORGAN Department of Clinical Investigation, University ofLeeds OSTEOMALACIA and osteoporosis are still some- in osteomalacia is an increase in the alkaline times confused because both diseases lead to a phosphatase activity in the blood (SAP); there deficiency of calcium which can be detected on may also be a low serum phosphorus or a low radiographs of the skeleton. serum calcium. This lack of calcium is the only feature Our experience with the biopsy of bone is that common to the two diseases which are in all a large excess of uncalcified bone tissue (osteoid), other ways easily distinguishable. which is the classic histological feature of osteo- malacia, is only found in patients with the other Osteomalacia typical features of the disease, in particular the Osteomalacia will be discussed first, because it clinical ones (Morgan et al., 1967a). Whether or is a clearly defined disease which can be cured. not more subtle histological techniques will detect Osteomalacia is the result of an imbalance be- earlier stages of the disease remains to be seen. tween the supply of and the demand for vitamin Bone pains, muscle weakness, Looser's zones, D. The the following description of disease is raised SAP and low serum phosphate are the Protected by copyright. based on our experience of twenty-two patients most reliable aids to the diagnosis of osteomalacia, with osteomalacia after gastrectomy; there is no and approximately in that order.
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Metabolic Bone Disease 5
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